Clinical and pathological observation of retinal changes after vitrectomy with internal limiting membrane peeling

Abstract

Purpose : Although retinal changes after vitrectomy with internal limiting membrane (ILM) peeling were noted, the detailed observation still remain unclear. To examine retinal changes after vitrectomy with ILM peeling, we examined clinical retinal changes in 3Dimensional-optical coherence tomography (3D-OCT) and pathological changes in the experimental model in cynomolgus monkeys.

Methods : To examine clinical retinal changes after ILM peeling, we observed 68 eyes with retinal detachment with 3D-OCT over 6 months after vitrectomy. In experimental monkeys, vitrectomy was performed followed by ILM peeling similar to clinical settings in human clinical cases. Ultrastructural changes were investigated by transmission and scanning electron microscopy over 3 years after ILM peeling.

Results : The 3D-OCT detected 45 eyes (66%) with ILM peeling-dependent retinal changes, including dissociated optic nerve fiber layer (DONFL) appearance, dimple sign, temporal macular thinning, peeling area thinning or forceps-related thinning. These changes developed in two months and remained thereafter. The ultrastructural studies showed that ILM peeled area was still clearly recognized after 3 years. The Müller cell processes covered most of the retina; however, the nerve fiber layer was partly uncovered and exposed to the vitreous space. The linear nerve fiber bundles were observed as comparable to DONFL appearance. Small round retinal surface defects were also observed around macula, resembling the dimple sign.

Conclusions : The clinical and pathological comparison showed clear correlation of detailed retinal changes observed after vitrectomy with ILM peeling. These changes were largely dependent on inner layers of the retina, especially glial remodeling in the retina.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.